Alcohol: how much is too much?

Studies that have reported that moderate consumption of alcohol may have health benefits for some people are now being questioned, with health organisations distancing themselves from the findings. While harm from drinking alcohol seems to depend on the amount you drink and your individual characteristics and circumstances, Australian guidelines state that there is no level of drinking alcohol that can be guaranteed completely safe.

Risks associated with alcohol

Drinking too much alcohol has several risks. In the short term, you risk:

accidents and injury;

violence;

reduced circulation;

sexual dysfunction;

raised stress levels; and

disturbed sleep (your sleep can be disturbed after as few as one or 2 drinks).

Over months and years, the risks of drinking too much include:

cancer;

high blood pressure;

stroke;

heart muscle damage;

inflammation of the liver and pancreas;

brain damage and memory loss; and

sexual problems.

If you drink alcohol, you can minimise your risk by aiming for low-risk drinking — a level of drinking at which there is likely to be little harm.

The National Health and Medical Research Council (NHMRC) currently recommends the following for low-risk drinking.

NHMRC recommendation for alcohol consumption

Guideline 1:

For healthy men and women, drinking no more than 2 standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

Guideline 2:

For healthy men and women, drinking no more than 4 standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

A single occasion of drinking is a sequence of consuming drinks without the blood alcohol concentration reaching zero in between.

Drinking less frequently over a lifetime (e.g. drinking weekly rather than daily) and drinking less on each drinking occasion, reduces the lifetime risk of alcohol-related harm.

What is a standard drink?

A standard drink is:

100 mL of wine;

one nip (30 mL) of spirits; or

one can or stubbie of mid-strength beer.

You may be surprised to know that:

one middy or pot (285 mL) of full-strength (4.9 per cent) beer is equal to 1.1 standard drinks;

425 mL (often called a schooner ) of full-strength beer is 1.6 standard drinks; and

an average restaurant wine glass contains 1.5 standard drinks.

The dangers of binge drinking

Binge drinking — drinking heavily over a short period or drinking continuously over a number of days or weeks — is thought to be especially harmful, even if you don’t do it very often.

How quickly you drink is also important — men are advised to drink no more than 2 standard drinks in the first hour, then no more than one drink per hour; women should have only one standard drink per hour.

Alcohol effects in men and women

Women tend to be smaller than men, resulting in women having less water in their bodies. This results in a higher blood alcohol concentration in women than in men for a given amount of alcohol.

Women tend to have smaller livers than men, making women more prone to liver damage from alcohol than men.

Women absorb alcohol more quickly than men and also tend to break it down more rapidly, meaning that harmful by-products of alcohol are generated in the body more quickly.

Women generally have more body fat than men, and alcohol is not absorbed into fatty tissue; this results in a higher blood alcohol concentration in women than men for a given amount of alcohol.

Also, women who take the oral contraceptive pill may break down alcohol more slowly than women who are not on the pill.

Despite these differences, at low levels of alcohol consumption there is little difference between men and women in terms of alcohol-related harm, according to the NHMRC. However, at higher levels of alcohol consumption the risk of alcohol-related disease increases more quickly for women, while the risk of alcohol-related injury increases more quickly for men.

Also, if men and women drink the same amount on a single occasion, women tend to reach a higher blood alcohol level, but men are more likely to be injured because, in general, they are more likely to engage in risk-taking behaviour.

Exceptions to the rule

The NHMRC has recommended that certain groups of people should drink less than the amounts in the general guidelines. Have a look at the table below to see whether you fall into one of these groups.

People who should drink less than the general guidelines

Group

NHMRC recommendation

Reason or comment

People doing activities that involve risk or require skill, e.g.:

driving

water sports

skiing

Avoid alcohol before and during these activities.

Even small amounts of alcohol affect judgement and performance.

People with a health or social problem linked to or made worse by alcohol, e.g.:

alcohol dependence

domestic violence

chronic hepatitis C

Temporary or permanent abstinence may be necessary.

You should discuss your alcohol intake with a health professional.

Continued drinking will cause further harm in people with significant alcohol dependence or major organ damage.

For some people with alcohol-related conditions, a planned programme of limited drinking under the supervision of a health professional may be appropriate.

People with a relative who has had alcohol dependence or another alcohol-related problem

Consider reducing the amount of alcohol to below the recommended amount for healthy adults.

Discuss your alcohol intake with a health professional

A family history of alcohol-related problems increases the risk that a person will be unable to control their drinking.

People taking medicines — this includes herbal remedies

Carefully read the labels and leaflets to check for interactions with alcohol.

Discuss possible interactions with your doctor or pharmacist.

You may need to limit your alcohol intake or stop drinking altogether.

Even at low levels, alcohol can interact with medicines — this can alter the effect of the alcohol and/or the medicine.

The greater the number of medicines taken, the higher the risk of interactions with alcohol.

People using illicit drugs, especially opioids such as heroin or methadone

Consuming alcohol with illicit drugs can have dangerous or lethal consequences.

Alcohol, heroin and methadone all depress brain activity.

Alcohol increases the risk of lethal opiate overdose.

Combining alcohol with stimulant drugs such as cocaine, methamphetamines and ecstasy increases the risk of dehydration, heart rhythm abnormalites and fits.

People with a mental health problem or disturbed sleep

If you drink, be very careful to stay within the recommended limits.

Consider not drinking at all — especially if you find it hard to limit your drinking or if your symptoms persist.

Check with your doctor or pharmacist about interactions between medicines and alcohol.

Older people are advised to consult their doctor about the most appropirate level of drinking for their health.

Older people tend to have a higher blood alcohol level than younger people for a given level of alcohol consumed.

Light to moderate alcohol consumption in older adults may lower the risk of several chronic conditions.

For some older adults, drinking alcohol increases the risk of falls and injuries, as well as some chronic conditions.

Many older people take medicines that can interact with alcohol.

Young adults (aged 18-25 years)

Be careful not to drink beyond the guideline limits, and take steps to avoid accidents and injuries.

Avoid alcohol for at least several hours before potentially risky activities like driving or swimming.

Don’t mix alcohol with other mood-altering drugs.

Statistically, young adults are most likely to be harmed by alcohol and to experience alcohol-related injury.

Younger, less experienced drinkers are at high risk due to their lower alcohol tolerance.

Alcohol affects brain development in young people, so drinking (especially heavy drinking) at any time before brain development is complete, which is not until about age 25, may adversely affect brain function.

Children and young people under 18 years of age

Not drinking alcohol is the safest option.

Children younger than 15 years are at greatest risk of harm from drinking alcohol, and for this age group, not drinking is especially important.

For young people aged 15-17 years, the safest option is to delay the initiation of drinking for as long as possible.

State and Territory Liquor Licensing Acts state that people younger than 18 cannot legally buy alcohol.

Laws differ among States and Territories in terms of the circumstances under which people younger than 18 can legally be supplied with alcohol in a private home.

Young people can tolerate less alcohol than adults due to smaller body size.

Alcohol can adversely affect brain development and lead to alcohol-related problems in later life.

People under the age of 15 are much more likely than older drinkers to undertake risky or antisocial behaviour connected with their drinking.

Risky behaviour is also more likely among those aged 15-17 – if drinking occurs in this age group it should be at a low risk level and in a safe environment, supervised by adults.

Women who are pregnant or who might soon conceive

[Includes women trying to conceive because the first weeks after conception are critical — women may not be aware they are pregnant at this stage]

Not drinking is the safest option.

Alcohol enters the developing fetus.

Drinking can contribute to congenital malformation, poor growth and behavioural problems. The level of risk is highest when there is high, frequent intake of alcohol by the mother.

The risk of harm to the fetus is likely to be low if a woman has consumed only small amounts of alcohol before she knew she was pregnant or during pregnancy. The level of risk to the individual fetus is influenced by maternal and fetal characteristics and is hard to predict.

Women who are breast feeding

Not drinking is the safest option.

Specifically, consider not drinking for the first month after delivery until breast feeding is well established.

For women who choose to drink after this period, alcohol should be limited to no more than 2 standard drinks per day, and women should avoid drinking immediately before breast feeding.

Women could also consider expressing milk in advance if they are planning to drink alcohol.

Alcohol passes into the breast milk. It may reduce milk supply and cause irritability, poor feeding and disturbed sleep in a breast-fed baby.

What if I’m having trouble controlling my drinking?

If you’re concerned about the amount you are drinking and are having trouble cutting back, help is at hand. Talk to your GP or contact one of the support groups that help people with alcohol problems.

Last Reviewed: 11 February 2015 myDr

References

1. National Health and Medical Research Council (NHMRC). Australian guidelines to reduce health risks from drinking alcohol. Commonwealth of Australia, published February 2009. Available at: http://www.nhmrc.gov.au/guidelines-publications/ds10 (accessed Feb 2015).

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